Provider Demographics
NPI:1851506836
Name:VALLEY MEDICAL CARE PC
Entity Type:Organization
Organization Name:VALLEY MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:D LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-586-2434
Mailing Address - Street 1:1801 SALMON CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7808
Mailing Address - Country:US
Mailing Address - Phone:907-586-2434
Mailing Address - Fax:907-586-2446
Practice Address - Street 1:1801 SALMON CREEK LANE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7808
Practice Address - Country:US
Practice Address - Phone:907-586-2434
Practice Address - Fax:907-586-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGR0224Medicaid
AKCT0241OtherRAILROAD MED. GRP NUMBER
AK0000WCHGTMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER